Legislation/Regulation > Organizational Policy/Guidelines

Miscommunication due to clinician use of medical jargon and limited patient health literacy is a persistent problem. This guidance suggests that physicians in the United Kingdom adopt a more direct approach to communication with their patients, such as encouraging physicians to write care letters and visit summaries directed to their patients.

Journal Article > Study

Prior research has shown that patients with limited health literacy are at increased risk for misunderstanding the appropriate dosing of acetaminophen, a commonly used nonprescription medication that can cause acute liver failure after an overdose. In this study, researchers examined the risk of nonprescription acetaminophen misuse among 500 English-speaking patients across 4 outpatient clinics. They found that 39% of participants had limited health literacy and 54% had low visual acuity. Both reduced visual acuity and lower health literacy were independent risk factors for dosing errors and for insufficient understanding regarding the simultaneous use of multiple acetaminophen-containing products. An AHRQ Literacy Toolkit is available that provides a business case for interventions, educational tools, and guides for engaging patients in health literacy discussions. A previous WebM&M commentary discussed an incident involving confusion with acetaminophen dosing.

Journal Article > Study

Correctly dosing liquid medications for children can be challenging for caregivers with limited health literacy. This cross-sectional analysis found that parents with limited English proficiency and health literacy were more likely to make dosing errors with liquid medications. These results affirm the need to redesign medication labels and dosing aids to promote safe use.

Journal Article > Study

Medication management in outpatient settings requires patients to recognize adverse medication effects. This expert review study found that standardized information from a large Canadian retail pharmacy lacked key information about possible adverse effects and drug interactions. The authors suggest that this information gap leads to an urgent and addressable patient safety risk.

Journal Article > Study

Misinterpretation of medication labels is a well-recognized source of medication error in the outpatient setting, especially among patients with low health literacy. This randomized controlled study looked at how units of measurement on medication labels and dosing tool characteristics affected dosing errors with regard to liquid medications in pediatrics. About 84% of parents made at least one dosing error, and 21% made at least one large error, defined as administering more than double the dose. Researchers concluded that the use of oral syringes resulted in fewer dosing errors than cups, especially when administering small doses. The authors conclude that oral syringes should be recommended when dispensing liquid medications in pediatrics. A prior WebM&M commentary discussed a pediatric dosing error.

Journal Article > Commentary

Limited health literacy can lead to patients misunderstanding care instructions. This commentary discusses organizational and individual strategies for primary care practices to help ensure patients can understand and act on the information they are given regarding their care, including avoiding the use of medical jargon, employing visual aids, and providing written information at a fifth- to sixth-grade reading level.

Tools/Toolkit > Government Resource

This updated AHRQ toolkit provides resources for primary care practices to ensure proper health literacy assessment and to promote greater understanding for all patients. The second edition includes methods to assess written patient education materials for ease of use, simplify the referrals process, and identify barriers to improving health literacy awareness.

Journal Article > Study

Overdose of acetaminophen—a commonly used over-the-counter medication—is the leading cause of acute liver failure in the United States, with the majority of cases being unintentional. Prior studies have shown that patients with limited health literacy frequently misunderstand dosing instructions for prescription medications, and this study examined the frequency with which adult patients misunderstood dosing instructions for acetaminophen. Patients were provided with actual bottles of medications and asked to demonstrate how many pills they could take during a day, alone or in combination with other analgesics. Under these simulated conditions, nearly half the patients would have overdosed either by exceeding the recommended daily dose of acetaminophen or by combining two acetaminophen-containing products. An AHRQ WebM&M commentary discusses a case of liver injury caused by incorrect dosing of acetaminophen.

Audiovisual > Audiovisual Presentation

This video reports on a sampling of prescriptions from major retail pharmacies that demonstrated gaps, inconsistencies, and lack of clarity in drug information distributed to patients with their medications.

Newspaper/Magazine Article

This newspaper article reports on factors contributing to the increasing number of consumer medication errors, including low literacy and confusing instructions, and discusses steps being taken to prevent such errors.

This study of geriatric patients discharged from a teaching hospital emergency department (ED) found that nearly 20% did not understand either their diagnosis or how to care for themselves at home, and the majority did not know the expected course of their illness or when to return to the ED. The study corroborates prior research showing that many ED patients do not comprehend their discharge instructions, and that a large proportion of hospitalized patients are unaware of their diagnosis. Many factors may play a role in this discrepancy, including low health literacy and suboptimal patient–provider communication. An AHRQ WebM&M perspective discusses the broader issue of patient safety in the emergency department.

Journal Article > Study

Elderly patients often rely on caregivers—either family members or paid workers—to assist with important medical tasks such as taking medications and accompanying patients to appointments. This study found that more than one third of paid caregivers had inadequate health literacy, and a similar proportion had impaired numeracy (difficulty applying arithmetic operations to common tasks). As low health literacy has been linked to misunderstanding medication instructions, these findings imply that paid caregivers may themselves be a source of patient errors in the ambulatory setting.

Journal Article > Study

Efforts to develop health literacy interventions are one strategy to improve medication safety. In pediatric populations, the need for parents to understand liquid medication dosing poses additional risks. This study evaluated the role of dosing instrument type (e.g., cups, droppers, syringes) on parents' medication administration errors. Investigators found that dosing accuracy was lowest when using cups, and that cups were also associated with the largest deviations in dosing errors administered. Limited health literacy was also associated with parents' dosing errors. The Joint Commission has published recommendations for improving patient–provider communication to address safety problems caused by low health literacy, an example of which is discussed in an AHRQ WebM&M commentary. Accompanying this article [see link below] is an Advice for Patients educational page that highlights pearls for medication safety in children.

Journal Article > Study

Patients' inability to correctly interpret prescription drug instructions may result in devastating errors, such as one discussed in this AHRQ WebM&M commentary. Research on minimizing these errors has focused on mitigating the relationship between low health literacy and misunderstanding drug labels that has been demonstrated in prior research. This study found that merely simplifying the text of drug warnings improved comprehension, and addition of pictorial icons to the warnings further improved comprehension among adults with low or marginal health literacy. Prior research has also successfully used visual aids to improve medication adherence in chronic disease management. The role of health literacy in patient safety is discussed in an AHRQ WebM&M perspective and interview.

Journal Article > Study

This survey revealed that many adults do not understand instructions for common liquid prescription medications, potentially increasing the risk of serious medication errors. Prior research in this field has demonstrated that low health literacy is an important predictor of misunderstanding prescription instructions. Concerningly, in this study nearly 1 in 5 patients who had adequate health literacy could not correctly interpret the instructions, and patients with marginal or low health literacy were at even greater risk. The Joint Commission has published recommendations for improving patient–provider communication to address safety problems caused by low health literacy, an example of which is discussed in an AHRQ WebM&M commentary.

Journal Article > Study

Recent studies have documented an increase in emergency department visits and deaths due to medication errors in outpatients. Such studies may be limited in their ability to provide a true picture of adverse drug events in the ambulatory setting, as the majority of medication errors are handled by poison control centers. This analysis of data from the National Poison Data System characterized more than 1 million out-of-hospital medication errors and found that only 7.5% required referral to a physician. Most errors involved nonprescription medications such as cough and cold medications, and dosing errors were frequently reported (similar to a prior study in a pediatric population). Reducing outpatient medication errors will require new approaches to patient education, especially in populations with low health literacy.

Journal Article > Commentary

While the patient safety field originated in studies of error in hospitals, safety in ambulatory care remains relatively less studied. Even within ambulatory safety, few studies address safety issues in chronic disease management, despite the fact that most medical care is provided in this context. In this article, the authors use evidence and case vignettes to develop a conceptual model of ambulatory safety and discuss how this model differs from the classic Donabedian triad. The framework emphasizes the role of health systems (including care coordination and information technology) and patient factors (such as health literacy) as determinants of safety and health outcomes.